Citation Nr: 21010629 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 14-38 420 DATE: February 25, 2021 REMANDED Entitlement to payment or reimbursement of medical expenses incurred from October 3, 2013, through October 5, 2013, at Shands Medical Center (SMC) is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1980 to December 1982. This appeal is before the Board of Veterans’ Appeals (Board) from a May 2014 decision of the North Florida/South Georgia Department of Veterans Affairs (VA) Health Care System in Gainesville, Florida. In September 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript is included in the claims file. In March 2019, the Board denied the Veteran’s claim on the basis that it was filed more than 90 days after October 5, 2013, and therefore was not timely. See 38 C.F.R. § 17.1004(d). She appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In July 2020, the Veteran, through her attorney, and the Secretary of Veterans Affairs submitted a Joint Motion for Remand (Joint Motion). In an August 2020 Order, the Court granted the motion and remanded the case to the Board. Entitlement to payment or reimbursement of medical expenses incurred from October 3, 2013, through October 5, 2013, at SMC is remanded. Initially, the file for the claim of entitlement to payment or reimbursement of medical expenses incurred from October 3, 2013 through October 5, 2013, at SMC cannot be located, and documentation pertinent to the appeal is not in the electronic record. Therefore, it must be remanded in order for the agency of original jurisdiction (AOJ) to reconstruct the record and upload all documentation related to the appeal to the electronic claims file. If such records are unable to be located, the AOJ should make a formal finding of unavailability. In addition, the AOJ should further develop the Veteran’s claim in accordance with the terms of the July 2020 Joint Motion. In the July 2020 Joint Motion, the parties determined that “the Board failed to provide an adequate statement of reasons or bases for its determination that the claim for reimbursement or payment was not timely.” Specifically, “it is not clear from the record or the Board’s decision what record it is referring to as the ‘March 2014’ claim from [SMC],” as “neither the North Florida/South Georgia VA Health Care System (HCS) May 2014 decision nor the Statement of the Case (SOC) identifies the date of any claim from [SMC]; rather, the VA HCS simply notes ‘[a]vailable information indicates that for this episode of care [at Shands on October 3, 2013, through October 5, 2013] the claims were not timely filed.’” The parties also found that the Board “failed to address material evidence of record,” and that the “the record indicates that non-VA care records are available but were not made part of the record.” Specifically, in the “VA treatment records from Gainesville VA Medical Center (VAMC) are several ‘administrative notes’ regarding fees related to the October 2013 care received at [SMC],” including one containing the “local title of ‘FEE INPATIENT (T),’ date of note October 5, 2013, and an entry date of December 28, 2013, [which] provides: Medical Documentation for Non-VA Care Services has been received and the results have been scanned. To see the results, open Imaging located on the Tools menu and select the image from the palette. FEE INP DOS/10-3-13-10-5-13 SHANDS JAX [] Notably, December 28, 2013, is within the 90 days after October 5, 2013.” The parties further noted “additional, substantially similar such records with entry dates of April 8, 2014,” and July 31, 2014, as well as “administrative notes with the local title ‘FEE ER (T)’” with entry dates of March 19, 2014, May 16, 2014, and August 13, 2014, all of which “provide that ‘Medical Documentation for Non-VA Care Services has been received and the results have been scanned,” and provide instructions for viewing such scanned documents. The parties therefore determined “that, on remand, the Board must ensure that the scanned documents are associated with [the Veteran’s] claims file,” and then “provide an adequate statement of reasons or bases as to the identification of the claim and the date of said claim(s), to include addressing the ‘FEE INPATIENT (T)’ VA administrative note with the entry date of December 28, 2013, regarding fees for inpatient care at [SMC] from October 3, 2013, to October 5, 2013, [], in addressing whether [SMC] submitted a timely claim for reimbursement from VA for the services provided by [SMC] in October 2013.” Finally, the parties noted that the Veteran, “in her May 2014 notice of disagreement (NOD)… indicated that she was submitting with her NOD ‘all of the bill[s] that I have been receiving,’”; while the Veteran did “not specify what documents she submitted, it [did] not appear that any such bills [were] of record.” The Board was to address “whether efforts to obtain these outstanding documents are warranted.” The matters are therefore REMANDED for the following action: 1. Reconstruct the record and upload all documentation related to the claim for payment or reimbursement of medical expenses incurred from October 3, 2013 through October 5, 2013, at SMC to the electronic claims file. If such records are unable to be associated with the record, make a formal finding of unavailability. 2. Make reasonable attempts to obtain the billing documents the Veteran identified in her May 2014 notice of disagreement including, if necessary, requesting that the Veteran identify and provide authorization for VA to obtain any such records. 3. Specifically associate with the claims file the dated claim for payment or reimbursement of medical expenses incurred from October 3, 2013, through October 5, 2013, at SMC. 4. Associate with the claims file the scanned documents related to the Veteran’s October 3 to 5, 2013, treatment at SMC, identified in the Gainesville VAMC administrative notes dated December 28, 2013; April 8, 2014; March 19, 2014; May 16, 2014; and August 13, 2014. 5. After completing the above and any other necessary development, readjudicate the appeal. If any benefit sought remains denied, provide a supplemental statement of the case to the Veteran. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Andrew Mack, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.